Prosthetic valve with infective endocarditis caused by Propionibacterium avidum. A case report / Endocarditis infecciosa protésica causada por Propionibacterium avidum

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Trends in the use of electrical cardioversion for atrial fibrillation: influence of major trials and guidelines on clinical practice.

BACKGROUND: The purpose of the present study was to assess the trends in the use of ECV following published studies that had compared rhythm and rate control strategies on atrial fibrillation (AF), and the recommendations included in the current clinical practice guidelines. METHODS: The REVERCAT is a population-based assessment of the use of electrical cardioversion (ECV) in treating persistent AF in Catalonia (Spain). The initial survey was conducted in 2003 and the follow-up in 2010. RESULTS: We observed a decrease of 9% in the absolute numbers of ECV performed (436 in 2003 vs. 397 in 2010). This is equivalent to 27% when considering population increases over this period. The patients treated with ECV in 2010 were younger, had a lower prevalence of previous embolism, a higher prevalence of diabetes, and increased body weight. Underlying heart disease factors indicated, in 2010, a higher proportion of NYHA ≥ II and left ventricular ejection fraction <30%. We observed a reduction in the number of ECV performed in 16 of the 27 (67%) participating hospitals. However, there was an increase of 14% in the number of procedures performed in tertiary hospitals, and was related to the increasing use of ECV as a bridge to AF ablation. Considering the initial number of patients treated with ECV, the rate of sinus rhythm at 3 months was almost unchanged (58% in 2003 vs. 57% in 2010; p=0.9) despite the greater use of biphasic energy in 2010 and a similar prescription of anti-arrhythmic drugs. CONCLUSIONS: Although we observed a decrease in the number of ECVs performed over the 7 year period between the two studies, this technique remains a common option for treating patients with persistent AF. The change in the characteristics of candidate patients did not translate into better outcomes.

[Prevalence of chronic wounds in a county in the province of Barcelona (Spain)]. / Prevalencia de la heridas crónicas en una comarca de la provincia de Barcelona.

OBJECTIVES: To determine the prevalence of chronic wounds in patients in a specific region and their distribution according to health resources. To classify wound typologies and the treatment provided. To examine the use of risk assessment scales and preventive measures. METHOD: A cross sectional study was performed between June 2 and 8, 2004 that included all the health centers of the distinct health areas of Osona County (Barcelona), with a population of 128,309 persons aged more than 14 years. Data were collected on patients diagnosed with chronic wounds and on the characteristics of these wounds. RESULTS: We studied 251 patients with a mean age of 77.5 years. A total of 377 chronic wounds were identified and there were 168 pressure ulcers. The prevalence of chronic wounds was 0.29% and that of pressure ulcers was 0.13%. The proportion of patients with lower limb ulcers was significantly higher in primary care than in acute and geriatric care (p<0.005). The proportion of patients with pressure ulcers was higher in acute and geriatric care than in primary care (p<0.005). Preventive scales were applied in 81 patients (92%) with pressure ulcers. CONCLUSIONS: Applying the concept of chronic wound was useful in identifying the high prevalence of lower limb ulcers. The distribution of wounds varied according to the health resources available.

Prevalencia de la heridas crónicas en una comarca de la provincia de Barcelona / Prevalence of chronic wounds in a county in the province of Barcelona (Spain)

Objetivos. Conocer la prevalencia de pacientes con heridas crónicas en una comarca y su distribución según el tipo de recursos asistenciales. Clasificar la tipología de dichas heridas y la terapéutica utilizada. Revisar la utilización del uso de las escalas de valoración de riesgo y las medidas de prevención. Método. Se presenta un estudio transversal, realizado entre el 2 y el 8 de junio de 2004, que comprende a todos los centros de los diferentes ámbitos asistenciales sanitarios de la comarca de Osona (Barcelona), con una población de mayores de 14 años de 128.309. Se recogió información acerca de los pacientes diagnosticados de heridas crónicas y las características de éstas. Resultados. Se estudiaron 251 pacientes con una edad media de 77,5 años. Se identificaron 377 heridas crónicas, concretamente 168 úlceras por presión. La prevalencia de las heridas crónicas fue de 0,29% y de las úlceras por presión de 0,13%. La proporción de pacientes atendidos de úlceras de extremidades inferiores en atención primaria era significativamente superior a la de los atendidos en los centros de agudos y sociosanitarios (p<0,005). La proporción de los atendidos en los centros sociosanitarios y de agudos, por úlceras por presión, era superior a la de los atendidos en atención primaria (p<0,005). Se aplicaron escalas de prevención a 81 (92%) de los pacientes que presentaron úlceras por presión. Conclusiones. La utilización del concepto de herida crónica evidencia una alta prevalencia de úlceras en extremidades inferiores, observándose una distribución diferente de ellas según los recursos asistenciales (AU)

Objectives. To determine the prevalence of chronic wounds in patients in a specific region and their distribution according to health resources. To classify wound typologies and the treatment provided. To examine the use of risk assessment scales and preventive measures. Method. A cross sectional study was performed between June 2 and 8, 2004 that included all the health centers of the distinct health areas of Osona County (Barcelona), with a population of 128,309 persons aged more than 14 years. Data were collected on patients diagnosed with chronic wounds and on the characteristics of these wounds. Results. We studied 251 patients with a mean age of 77.5 years. A total of 377 chronic wounds were identified and there were 168 pressure ulcers. The prevalence of chronic wounds was 0.29% and that of pressure ulcers was 0.13%. The proportion of patients with lower limb ulcers was significantly higher in primary care than in acute and geriatric care (p<0.005). The proportion of patients with pressure ulcers was higher in acute and geriatric care than in primary care (p<0.005). Preventive scales were applied in 81 patients (92%) with pressure ulcers. Conclusions. Applying the concept of chronic wound was useful in identifying the high prevalence of lower limb ulcers. The distribution of wounds varied according to the health resources available (AU)